Low anterior resection syndrome

Abstract

Low anterior resection syndrome (LARS) is the distressful defecatory functional problem after sphincter‐saving surgery for rectal cancer. Although the symptoms of fecal urgency, frequency, and incontinence may develop in most of the patients after surgery, there is no definitive treatments for LARS. Multifactorial etiologies and various risk factors have been identified, but the reduction of storage capacity in the rectum is one of the main reasons for LARS. Anal sphincter muscle or nerve damage during rectoanal resection or anastomosis construction, and intersphincteric resection for low‐lying tumors or hand‐sewing anastomosis, are the absolute risk factors for LARS. Preoperative radiotherapy, postoperative complications, such as anastomosis leakage, or longer duration of stoma, are also risk factors. The severity of LARS can be confirmed using the LARS score questionnaire. The questionnaire has been translated to numerous language versions including Korean and have been validated. Diverse empirical treatments, such as loperamide, fiber, probiotics, or enema, have been tried, but the safety and efficacy have not been verified yet. The 5‐Hydroxytryptamine (5‐HT) receptor antagonist, ramosetron, used for diarrhea‐dominant irritable bowel syndrome, is one potential drug for relieving the symptoms of major LARS. A randomized‐controlled trial suggested the use of ramosetron could be safe and efficacious for patients who have major LARS after sphincter‐saving rectal cancer surgery. Novel techniques or drugs for relieving the symptoms of LARS should be developed more and further studies are necessary.

Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial

“…LARS pathogenesis involves multiple theories, including anal internal sphincter dysfunction, reduced rectal sensitivity, the absence of the rectoanal inhibitory reflex, and reduced rectal compliance [ 6 ]. Nerve damage during the low anterior resection process might lead to new rectal innervation, exacerbating the LARS symptoms [ 7 ].…”